Tuesday 9 April 2013 10.30 EDT
First published on Tuesday 9 April 2013 10.30 EDT

One aspect of last week's NHS shakeup that has received little coverage is the launch of Healthwatch, billed as the new "consumer champion" for health and social care in England. At its helm is Anna Bradley, the former director of the National Consumer Council.

One reason for Healthwatch's low profile may be that there has been a good deal of cynicism about patient representation in the NHS since the abolition of community health councils (CHCs) in 2002. Certainly, the two shortlived successor arrangements – patient and public involvement forums (PPIFs) from 2002 to 2008, and local involvement networks (Links) since 2008 – can, on the whole, hardly be judged success stories.

Indeed, Robert Francis QC was caustic about the record of PPIFs and Links in his recent public inquiry report on the Staffordshire hospitals scandal. "Whatever the faults of CHCs," he wrote, "it is now clear that what replaced them, at two attempts in 10 years, did not produce an improved voice for patients and the public but achieved the opposite." In Staffordshire, he said, the bodies "quickly broke down under dysfunctional relationships and infighting, while the lack of support [for them] led to a preoccupation with constitutional arrangements rather than patient concerns".

The Staffordshire affair reminds us of the critical importance of patient and public involvement in the care system – and of what can happen when the voices of patients and family carers are not heard. As Francis said, such involvement "starts and should be at its most effective on the frontline".

For Bradley, chair of Healthwatch England, Francis's challenge must seem double-edged. On one hand, it will strengthen her position with ministers when it comes to negotiation over resources for her new national body and the network of 152 local Healthwatch organisations it oversees. On the other, it considerably raises the stakes on the risk of her presiding over a third consecutive failure of patient/consumer representation in the NHS.

Bradley, who has spent much of her career in the consumer movement, is adamant that using the word consumer is appropriate. Not only does it get past argument over "patient" or "service user" and embrace carers too, but it takes the whole agenda into the territory of rights: the right to make choices about care, the right to say what you think and be listened to, the right to complain and to have your complaint investigated.

"Yes, we are very grateful for what we get in health and social care; we know we are very lucky in the UK," she says. "But we think we could do better and there are some things we expect. It's quite a good conversation to be having."

Some of the Healthwatch groups are better prepared for that conversation than others. Seventy-five have been operating in shadow form to pilot the model. Others, however, are barely off the starting blocks and "interim arrangements" are in place in four areas – though Bradley stresses that there is someone on the end of a Healthwatch phone everywhere in England.

The groups are being hosted by, and funded through, local authorities and each will have a seat on the council's new local health and wellbeing board. Bradley, who is being paid just under £48,000 a year for her part-time role, has a place on the board of the care inspectorate, the Care Quality Commission, which is hosting Healthwatch England. Will that compromise her?

"I am expecting a time to come when we at Healthwatch England may have some difficult things to say to the CQC," she says. "In that event, I am quite sure that the CQC board will want to discuss them and I will want to excuse myself from that conversation."

Apart from that, she foresees no conflicts of interest. Others, however, are doubtful about how independent Healthwatch will be, both nationally and locally, and Peter Walsh, chief executive of the charity Action Against Medical Accidents, which played a key role in exposing the Staffordshire scandal, is among those who have questioned the chances of it performing any better than did the PPIFs or Links.

Francis himself has called for a consistent structure, where councils are required to pass on the full £43.5m funding allocated by the government to set up and run their local Healthwatch. There is no such requirement at present, and in Manchester there has been a prominent clash: local Healthwatch supporters say the council resolved to pass on only £80,000 of the £431,000 it had been allocated.

Bradley has asked health secretary Jeremy Hunt to set a minimum amount that each council should pass on, and she sees this request, set out in a public letter to the minister to which, she says, he is obliged to reply publicly, as a significant marker of Healthwatch England's determination to show its independence. In recruiting to the body's 12-strong national committee, she says she deliberately sought "feisty" individuals such as Christine Lenehan; director of the Council for Disabled Children; Patrick Vernon, a Labour councillor in Hackney, east London; and John Carvel, a former Guardian social affairs editor.

It was the committee's decision to write the public letter, which also called on Hunt to accept Francis's recommendation to impose a legal duty of candour on individual care professionals when things go wrong, rather than merely on care organisations as he has announced.

"We say that with some sorrow, as it seems quite wrong to have to put in place a statutory requirement that people tell the truth," says Bradley. "But it's the place we are in, unfortunately."

As an experienced quango chair and former non-executive director of her local NHS trust in Colchester, Essex, she expects to raise most issues "in conversation" with ministers and officials. Her style is plainly more suited to behind-the-scenes lobbying than to grandstanding. "But, frankly," she warns, "if we are not listened to, we will do what we need to do to ensure that the consumer voice is properly heard and responded to."

She expects this approach to be reflected by local Healthwatch groups: "We now have guidance from the government and the Local Government Association to local Healthwatches, making it clear that they can campaign."

Bradley is proud that Healthwatch is, as she puts it, the single element of this month's NHS changes that commands all-party support. "I'm very confident that this is something that can be made to really work – and by work, I mean deliver some significant benefits to consumers of health and social care," she says.

"There is, if you like, a 'moment': this is set in a context where everyone in health and social care is charged with the responsibility of properly engaging with, involving, consumers and users. Our task is to keep the system honest and make sure they do that."

Curriculum vitae

Age 55.

Family Married, two adult children.

Home Colchester, Essex.

Education Camden school for girls, north London; University of Warwick (BA philosophy, MBA).